拉米夫定治疗慢性乙型肝炎的疗效及肝组织学改变

A Investigation of the Clinical Effect and Liver Histological Change by Lamivudine in Treatment of Chronic Hepatitis

目的:观察拉米夫定治疗慢性乙型肝炎的临床疗效。方法:随机选择慢性乙型肝炎患者5 0例,给予口服拉米服定10 0 mg/ d,连用1a,动态观察服药0、6、12个月肝功能、HBV- DNA定量、血清肝纤维化指标透明质酸(HA)、层粘蛋白(L N)、型前胶原(P P)和 型胶原( C)的变化,对其中10例治疗前后行肝组织穿刺活检,观察肝脏组织学的改变。结果:与对照组相比,拉米夫定治疗组治疗后AL T、AST水平下降,HBV- DNA定量和4项血清肝纤维化指标均明显降低(P<0 .0 1)。肝细胞坏死、汇管区炎细胞浸润及纤维化明显减轻。结论:拉米夫定治疗慢性乙型肝炎,可以明显降低血清HBV- DNA及转氨酶水平,延缓肝组织纤维化的进展,减轻肝组织的炎症坏死。

Objective:To investigate the clinical effect of Lamivudine in the treatment of chronic hepatitis B.Methods:Fifty patients with chronic hepatitis B were selected randomly and treated with Lamivudine 100 mg daily for one year.Then HBV-DNA copy number, Alanine aminotransferase (ALT) and aspartate aminotransferase(AST) level, HA, LN, PIIIP and IVC at the time point of 0, 6, 12 months during treatment were detected. In addition, the needle biopsy of liver were performed in ten patients before and after treatment to observe histopathological changes of liver tissue.Result:Compared with control group, ALT and AST levels were lower in the lamivudine treated patients, HBV-DNA level and four items of hepatic fibrosis markers in serum were also detected with significant decrease (P<0.01) in these patients.Furthermore,in the lamivudine treated patients,evident decrease of inflammation and fibrosis was observed in portal vein of the liver tissue.Conclusion:Lamivudine treatment could decrease the HBV-DNA and transaminase level, and delay the progression of liver fibrosis and lighten inflammation and necrosis of liver.